Modern surgery, general and operative . to haveascended and passed posteriorly; there is no shortening of the thigh; all themotions of the hip-joint can be obtained; if the thigh is flexed, abducted, androtated externally, and the fragment is pushed downward and forward, crepitusmay be obtained—soft in epiphyseal separation, hard in fracture. There is noshortening. If the process is not completely separated, diagnosis is impossiblewithout the ic-rays. Treatment.—If the epiphysis is not completely separated, immobilize thelimb in the position of abduction. If it is completely separated, incise
Modern surgery, general and operative . to haveascended and passed posteriorly; there is no shortening of the thigh; all themotions of the hip-joint can be obtained; if the thigh is flexed, abducted, androtated externally, and the fragment is pushed downward and forward, crepitusmay be obtained—soft in epiphyseal separation, hard in fracture. There is noshortening. If the process is not completely separated, diagnosis is impossiblewithout the ic-rays. Treatment.—If the epiphysis is not completely separated, immobilize thelimb in the position of abduction. If it is completely separated, incise thesoft parts and either suture or nail the fragment in place. Fractures of the shaft of the femur may affect any portion of the shaft,but especially the middle third, and may occur at any age. Fracture^ ofthe upper third is a rare accident. AUis estimates that each year in Phila-delphia there is i case of fracture of the upper third of the femur to every100,000 inhabitants. Separation of the lower epiphysis occasionally Fig. 351.—Iiiti-TtrDrluinti-ric fracture. Poland in 1898 594 Diseases and Injuries of the Bones and Joints The cause of fractures in the upper third is usually indirect force; fracturesin the lower third are due to direct force; and in fractures of the middle thirdthese two causes are about equally potential. Fracture from muscular actionoccasionally occurs. Oblique fracture is the usual variety. In many casesthe soft parts are badly lacerated and sometimes a great vessel is torn. Symptoms.—The chief symptom in fracture of the shaft of the femuris great displacement, except when impaction occurs, when the break is dueto direct force, or when the injury is in a child. In a child the line of frac-ture is often transverse and the periosteum may be untorn. Green-stickfractures occur in children. As a rule, in fracture of the shaft of the femurthe lower fragment is drawn upward and the upper end of the lower fragment
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
